avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic...

8/13/2019 Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome ris

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RE S EAR C H Open Access

Avocado consumption is associated with betterdiet quality and nutrient intake, and lowermetabolic syndrome risk in US adults: resultsfrom the National Health and NutritionExamination Survey (NHANES) 20012008Victor L Fulgoni III1* , Mark Dreher2 and Adrienne J Davenport3

Abstract

Background: Avocados contain monounsaturated fatty acids (MUFA) dietary fiber, essential nutrients andphytochemicals. However, no epidemiologic data exist on their effects on diet quality, weight management andother metabolic disease risk factors. The objective of this research was to investigate the relationships betweenavocado consumption and overall diet quality, energy and nutrient intakes, physiological indicators of health, andrisk of metabolic syndrome.Methods: Avocado consumption and nutrition data were based on 24-hour dietary recalls collected by trainedNHANES interviewers using the USDA Automated Multiple Pass Method (AMPM). Physiological data were collectedfrom physical examinations conducted in NHANES Mobile Examination Centers. Diet quality was calculated usingthe USDAs Healthy Eating Index-2005. Subjects included 17,567 US adults 19 years of age (49% female),including 347 avocado consumers (50% female), examined in NHANES 2001 2008. Least square means, standard

errors, and ANOVA were determined using appropriate sample weights, with adjustments for age, gender, ethnicity,and other covariates depending on dependent variable of interest.Results: Avocado consumers had significantly higher intakes of vegetables (p < 0.05); fruit, diet quality, total fat,monounsaturated and polyunsaturated fats, dietary fiber, vitamins E, K, magnesium, and potassium (p < 0.0001);vitamin K (p = 0.0013); and lower intakes of added sugars (p < 0.0001). No significant differences were seen incalorie or sodium intakes. Body weight, BMI, and waist circumference were significantly lower (p < 0.01), and HDL-Cwas higher (p < 0.01) in avocado consumers. The odds ratio for metabolic syndrome was 50% (95th CI: 0.32-0.72)lower in avocado consumers vs. non-consumers.Conclusions: Avocado consumption is associated with improved overall diet quality, nutrient intake, and reducedrisk of metabolic syndrome. Dietitians should be aware of the beneficial associations between avocado intake, dietand health when making dietary recommendations.

Keywords: Avocado, Persea americana, Persea americana mill, Metabolic syndrome, Nutrient intake, BMI,Antioxidant

* Correspondence: [email protected] Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, MI 49014, USAFull list of author information is available at the end of the article

2013 Fulgoni et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

Fulgoni et al. Nutrition Journal 2013, 12 :1http://www.nutritionj.com/content/12/1/1
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BackgroundDietary guidelines around the world recommend increa-sed consumption of fruit and vegetables because they havelow-to-medium energy density and are important contri-butors of major shortfall nutrients including dietary fiber, vitamins A, C and K, magnesium, and potassium [ 1,2].Fruit and vegetables contain a diverse mixture of phyto-chemicals that may help support health and wellness andpotentially reduce the risk of chronic diseases [ 3]. Data in-dicate that in the US,


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ResultsThe NHANES 2001 2008 sample included 17,567 individuals 19 years of age (49% female). Data indicate thatapproximately 2% of individuals were avocado consumers(n = 347; 50% female). Mean avocado intake (Table 1) was70.1 5.4 g/d (approximately one half of a medium-sizedfruit), which contains about 114 calories of which 95 cal-

ories come from fat [ 5,35]. Consumption of avocados washigher in males than females.

Compared to non-consumers, diet quality (Table 2) wassignificantly (p < 0.0001) higher in avocado consumers.The latter had significantly (p < 0.05) higher intakes of fruit and vegetables and lower intake of added sugars.There were no significant differences between consumersand non-consumers for intakes of total grains, wholegrains, dairy, meat and beans, and discretionary fats (as oilor solid fat).

Compared with non-consumers, those who ate avoca-dos (Table 3) had significantly (p < 0.0001) higher intakes

of total fat, monounsaturated fat, polyunsaturated fat,dietary fiber, vitamin E, magnesium and potassium, and vitamin K (p = 0.0013). Avocado consumers had signifi-cantly lower carbohydrate (p < 0.001). No significant dif-ferences were seen in calorie or sodium intakes. Thosewho ate avocados had significantly (p < 0.01) lower body

weight, BMI, and smaller waist circumference (Table 4).HDL-C was significantly (p < 0.01) higher in avocado con-sumers compared to non-consumers. The odds ratio formetabolic syndrome was 50% lower in those who ate avo-cados compared to those who did not (95% confidenceinterval [CI]: 0.34, 0.72).

DiscussionThis is the first report to investigate avocado consump-tion among the US population 19 years of age, andexplore its relationships to diet quality, energy and nutri-ent intakes, and physiological markers of health. In thisreport, avocado consumption was associated with signi-ficant differences in diet quality and nutrient intakes,higher HDL-C levels, and lower body weight, BMI, waistcircumference, and risk of metabolic syndrome. The im-proved diet quality, nutrient intake, and HDL-C outcomes

associated with avocado consumption are consistent withthe avocado composition and clinical data [ 5,9-16]. Sinceenergy intake was not different between consumers andnonconsumers, the reported lower body weight, BMI andwaist circumference for the avocado consumers needs tobe further investigated. The effect of diets on weight con-trol may be dependent of a number of factors such as en-ergy density, macronutrient bioavailability, and potentially other factors such as food physical properties [ 36-38]. Epi-demiological evidence and intervention studies generally support the association between the consumption of en-ergy-dense/high-fat diets with being overweight [ 36,37].

Insulin resistance, a key pathogenic link underlying thecluster of metabolic abnormalities seen in metabolic syn-drome, is adversely effected by saturated fat and improvedwith MUFA [ 39-41]. Tree nuts, which are similar to avo-cado in dry weight composition including dietary fiberand MUFA content, have not been shown to increase

Table 1 Average daily avocado consumption by gender 1,2

Avocado Consumption

(g/d)

Total (n = 347) 70.1 5.4

Males (n = 174) 75.3 6.3Females (n = 173) 66.7 7.31 Data Source: NHANES 20012008; analyses adjusted for complex sampledesign and using sample weights.2 Least square mean standard error of the mean.

Table 2 Diet quality and average daily serving intakes of MyPlate food groups for avocado consumers andnon-consumers 1

Food group Consumers (n = 347) Non-consumers (n = 17,220) p-value

Healthy Eating Index - 2005 57.1 1.52 50.8 0.2 0.0001

Fruits (cup equiv./d) 1.6 0.1 1.0 0.02 < 0.0001

Vegetables (cup equiv./d) 1.8 0.1 1.6 0.02 < 0.05 Total Grains (oz equiv./d) 6.8 0.04 6.8 0.04 n.s.3

Whole Grains (oz equiv./d) 0.7 0.09 0.7 0.02 n.s.

Dairy (cup equiv./d) 1.6 0.1 1.6 0.02 n.s.

Meat and Beans (oz equiv./d) 5.9 0.3 6.1 0.1 n.s.

Added sugar (tsp/d) 15.7 0.9 19.7 0.3 < 0.0001

Discretionary fat, Oils (g/d) 21.0 1.3 19.0 0.2 n.s.

Discretionary fat, Solid (g/d) 46.8 0.2 43.4 1.8 n.s.1 Data Source: NHANES 20012008, n = 17,567; analyses adjusted for complex sample design using sample weights with age, gender, ethnicity, poverty incomeratio, self-reported physical activity level, smoking status, alcohol intake, and energy intake as covariates.2 Least square mean standard error of the mean.3 n.s.: not significant.

Fulgoni et al. Nutrition Journal 2013, 12 :1 Page 3 of 6http://www.nutritionj.com/content/12/1/1


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body weight or metabolic syndrome risk in numerous cli-nical and epidemiological studies [ 42-46].

Epidemiologic studies dating back to the 1970s show the health benefits of MUFAs [ 45]. The Seven CountriesStudy found that death rates were positively related to theaverage percentage of energy from saturated fatty acids(SFAs) and negatively related to the percentage of dietary energy from MUFAs [ 47]. Prospective studies of USnurses have demonstrated an estimated reduction of 19%in the risk of coronary disease when the intake of MUFAs

is increased by 5% (as a percentage of total energy intake)[48]. More recently, Moreno et al. [ 49] found that aMUFA-rich diet may have favorable effects on cardiovas-cular risk by preventing the oxidative modifications of LDL-C and reducing macrophage uptake of plasma oxi-dized LDL. Studies also suggest that MUFAs may have amodest antihypertensive effect and could improve insulinsensitivity [40].

Results of this study indicate avocado consumptionis associated with improved nutrient intakes includinghigher intake of mono- and polyunsaturated fat, dietary fiber and several vitamins and minerals; lower body

weight, BMI, and waist circumference; higher HDL-C;and decreased risk of metabolic syndrome. These fin-dings suggest a role for avocados in improving dietary quality and possibly reducing the risk of metabolic syn-drome in the United States. Further research is neededto verify this epidemiological data and study the poten-tial association between increased intake of avocadosand other dietary components.

Limitations of the study

Energy and food group/nutrient intakes, including HEI-2005 scores, in this study were based on single 24-hourdietary recalls. While dietary recalls were collected viaAMPM, the best methodology available, there are stilllimitations to this dietary collection method [ 24]. Recallsmay be inaccurate and biased due to misreporting ormemory lapses. Even though the AMPM method hasbeen validated against weighed food records, energy canbe underestimated by 3% for a population of normalweight and up to 11% for overweight and obese persons[18,24].

The present report comes from cross-sectional epi-demiological data and thus cannot provide causal evidencebetween avocado consumption and improvements in dietquality, nutrient intakes, body weight, BMI, waist circum-ference, or indices of health. The number of avocado con-sumers was relatively small and while we used numerouscovariates in an attempt to remove effects of other vari-ables, residual confounding may still exist. The associa-tions reported here should be interpreted accordingly.

ConclusionsThis study is the first to explore associations between avo-cado consumption and diet quality, nutrient and energy intakes, and metabolic disease risk factors in a stratified

Table 3 Average daily nutrient intakes for avocado consumers and non-consumers 1

Component Consumers (n = 347) Non-consumers (n = 17,220) p-value

Calories, kcal 2250 652 2190 11 n.s.3

Total fats (g) 92.0 1.6 82.9 0.3


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random sample of the total civilian, noninstitutionalizedUS population. Use of NHANES estimates makes it pos-sible to generalize findings to the population at large. Thedata demonstrate significant associations between avocadoconsumption and a higher HEI diet quality score andnutrient intakes; lower body weight, BMI, and waistcircumference; higher HDL-C levels; and reduced riskof metabolic syndrome. Dietitians can recommend con-sumption of avocados as part of a healthful diet that fo-cuses on increased fruit and vegetable intake. Avocadoscan be incorporated into the diets of most adults, and may be of additional benefit to those who have increased riskfor metabolic disease risk factors.

This study was supported by the Hass Avocado Board.

Competing interestsVLF as Senior Vice President of Nutrition Impact, LLC performs consultingand database analyses for various food and beverage companies and related

entities. MD is a nutrition science consultant for various food companies andrelated entities including the Hass Avocado Board. AJD is an analyst forSchool Nutrition Programs within the Michigan Department of Educationand also serves as a freelance nutrition consultant.

Authors contributionsVLF designed the study, was primarily responsible for the data analysis, andprovided critical input into the manuscript; MD and AJD helped with dataanalysis and drafted the manuscript. All authors read and approved the finalmanuscript.

Author details1 Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, MI 49014, USA.2 Nutrition Science Solutions, LLC, 900 S. Rainbow Ranch Rd, Wimberley, TX78676, USA. 3 3651 Toles Rd, Mason, MI 48854, USA.

Received: 1 August 2012 Accepted: 30 December 2012Published: 2 January 2013

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doi:10.1186/1475-2891-12-1Cite this article as: Fulgoni et al. : Avocado consumption is associatedwith better diet quality and nutrient intake, and lower metabolicsyndrome risk in US adults: results from the National Health andNutrition Examination Survey (NHANES) 2001 2008. Nutrition Journal 2013 12:1.

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